急性乙型肝炎血清学、病毒学某些指标动态变化研究

目的 通过对急性乙型肝炎（AHB）临床特征、病毒学动态变化及病理特征的分析,探讨AHB的临床特征及转归.方法 分析首都医科大学附属北京地坛医院2012年1月至2013年8月确诊的155例AHB患者的血清学、病毒学资料及22例AHB患者的病例资料.结果 AHB发病以男性多见（男与女性比为1.87∶1）,高发年龄段为20～ 49岁（81.2％）,81.9％传播途径不明,11.0％与HBV患者或携带者有性接触史,7.1％有乙肝家族史、吸毒史、看牙史或纹身史,100％无乙肝疫苗接种史.患者入院时ALT、AST、TBiL及乙型肝炎核心抗体（HBcIgM）的0（χ）±s分别为1531.56±790.764 U/L,698.64±499.844 U/L,102.04±70.194 μmol/L,23.70±8.427S/CO. ALT、AST、TBiL、HBsAg、乙肝E抗原（HBeAg）、HBV DNA定量恢复正常时间的M分别为30 d、30 d、30 d、30 d、7d、7d.结论 AHB的发病年龄以中青年为主,性接触可能为最主要的传播途径;AHB的预后好,但仍有部分会发生慢性化;绝大部分患者2个月内转氨酶及黄疸恢复正常,3个月内HBsAg转阴;对3个月时HBsAg仍未转阴的患者进行抗病毒治疗,能改善其转归.

Dynamic changes of acute hepatitis B serologic and virologic markers

Objective To analyze the dynamic changes of the clinical characteristics and virology of acute hepatitis B and the pathological characteristics and to investigate the clinical features and prognosis of acute hepatitis B.Methods Analysis was performed on the serology and virology of 155 acute hepatitis B patients,and pathological characteristics of 22 acute hepatitis B patients were analyzed,all cases were inpatients admitted from January 2012 to August 2013 in Beijing Ditan Hospital affiliated to Capital Medical University.Results The male∶ female ratio was 1.87∶ 1,most of the patients were 20-49 years of age （81.2%）,in 81.9% of cases the route of transmission was unknown,11.0% of patients with AHB had the history of sexual contact with hepatitis B patients or carriers,7.1% AHB have a family history of hepatitis,drug history,dental treatment history or the history of tattoos,none had hepatitis B vaccination history.ALT,AST,TBiL and anti HBc IgM of hospitalized patients were 1531.56 ± 790.764 U/L,698.64 ±499.844 U/L,102.04 ± 70.194 μ,mol/L and 23.70 ± 8.427 S/CO.ALT,AST,TBiL HBsAg,HBeAg andHBV DNA median recovery time respectively were 30 days,30 days,30 days,30 days,7 days and 7 days after disease onset.Conclusion Age of onset of acute hepatitis B at young or middle age,sexual contact may be the most important route of transmission.The prognosis of acute hepatitis B is good,but some cases still progressed into chronic hepatitis.The transaminase and jaundice of most patients returned to normal within two months,HBsAg seroconversion occurred within three months.At 3 months,HBsAg positive patients who received antiviral therapy would have better outcome.